TRAUMA TRIAGE - A 9-YEAR EXPERIENCE

Study objective: To describe the Orange County trauma system's nine-year (July 1980 through June 1989) experience with patient triage. Changes in patterns were sought after the 1983 revisions in triage criteria. Design: A nine-year retrospective analysis of trends in trauma patient triage in Orange County. A pre-analysis and postanalysis to discern changes in trends after a July 1983 revision in triage criteria was conducted. Setting: Orange County, California, Emergency Medical Services (EMS) Agency, serving an urban population of more than 2 million. Orange County EMS responds to about 90,000 calls annually, 3,500 of which are for trauma patients. Twenty-eight nontrauma and neurosurgical paramedic receiving centers and four paramedic trauma receiving centers served the community during the study period. Type of participants: All patients triaged to Orange County trauma centers between July 1980 and June 1989. Single neurologic injury patients were triaged to neurosurgical receiving centers and are not included. Interventions: None. Measurements and main results: Logarithmic regression analysis showed a 386% increase in the number of trauma patients triaged to trauma centers. The number of more seriously injured patients, as estimated by length of hospital stay of more than four days; Injury Severity Score of more than 15; fatality, or patients requiring surgery within six hours for trauma to the chest, abdomen, central nervous system, and/or major vessel, also increased. The rates of increase were more than those of the population (15%) for the Injury Severity Score of more than 15 group (79%) and the length of stay of more than four days group (108%), but lower for the fatality group (11%) and the early surgery group (7%). Because traffic and motor vehicle accidents comprise 70% to 80% of all trauma injuries, a separate analysis was conducted for these cases, using numbers of miles traveled as a basis for analysis. The analysis revealed a significant (alpha = .05) increase in overtriage rate, from 43% in 1981 to 74% in 1988, for motor vehicle accident patients. No changes in trends were found in the pre-analysis and postanalysis. Changes in trends occurred in 1986. Conclusion: The growth rate for the total trauma population exceeds that for overall county population growth. These results suggest overtriage. No changes in trends were found after the 1983 revisions in triage criteria. Changes in trends were found in 1986 after the revisions in the Injury Severity Score scoring system.